When it comes to life expectancy in high-income English-speaking countries, a new study finds America has ranked last since 2001. Despite its abundance of deadly animals, Australia continues to perform best, and researchers say the U.S. should serve as a model for how to do better.
Life expectancy in wealthier countries is a good indicator of a population’s health profile, driven by factors such as their behavior, socioeconomic trends, and availability of health care. For example, in 1900, life expectancy was 32 years; in 2021, it was 71. This improvement can be attributed to improvements in medicine, public health, and living standards.
In a new study, researchers from the University of Southern California and the Pennsylvania State University (Penn State) examined life expectancy in six high-income English-speaking countries—the U.S., U.K., Ireland, Canada, Australia, and New Zealand—to see how each ranks.
“One lesson we can learn about life expectancy as Americans by looking at similar countries is where the boundary of optimal performance lies,” said Jessica Ho, an associate professor of sociology and demography at Penn State and senior author of the study. “Yes, we are doing poorly, but this study shows what we can aim for. We know that these gains in life expectancy are actually achievable because other major countries have already done it.”
The researchers obtained data from the Human Mortality Database and the World Health Organization Mortality Database for six countries between 1990 and 2018. For context, they also looked at data from other high-income countries between 1990 and 2019: Austria, Belgium, Denmark, Finland, France, Germany, Italy, Japan, the Netherlands, Norway, Portugal, Spain, Sweden, and Switzerland. These countries were not included in the rest of the analysis; they were used only to see how the six English-speaking countries ranked within the larger set of 20 countries.
Researchers analyzed data across six Anglophone countries by sex, age, and 18 mutually exclusive and exhaustive categories of causes of death, including various cancers, heart disease, drug and alcohol-related deaths, infectious diseases, firearm deaths, and motor vehicle crash deaths. They not only compared data across countries, but also examined life expectancy within each country to identify regional disparities.
Australia topped the list for life expectancy, with Australian women living almost four years longer than American women and Australian men living almost five years longer than American men. For most of the study period, Canada had the second-highest life expectancy, but more recently Ireland and New Zealand have caught up with the Great White North. Over the past 10 years, the United Kingdom has had the second-lowest life expectancy overall. Australia has a one-to-2.5-year life expectancy advantage over Canada, New Zealand, Ireland and the United Kingdom. The United States has performed worst in every year since 2001.
Looking at the factors contributing to causes of death, the researchers’ analysis showed that Australians had lower mortality rates at almost all ages, but the life expectancy advantage for Australians increased between the ages of 45 and 84. They had lower rates of death from external causes such as drug and alcohol abuse, screenable and/or treatable cancers, heart disease and flu/pneumonia.
Perhaps unsurprisingly, drug overdoses, other external causes, and cancers dominated the 25 to 44 age group. Drug overdoses were the largest contributor to the deficit in the United States and also contributed to the deficit in Canada and the United Kingdom. Motor vehicle crashes contributed to the deficit in the United States and New Zealand, but the other countries have lower mortality rates than Australia. Australian women had an advantage in cancer mortality compared with all other countries except Canada. Gunshot-related deaths were the only significant contributor to the gap between American and Australian women.
“One of the primary reasons why American longevity is so much shorter than in other high-income countries is that our youth die at higher rates from largely preventable causes of death, such as drug overdoses, car accidents and homicide,” Ho said.
In the 45 to 64 age group, heart disease, other circulatory diseases, cancers, and lung diseases were major contributors to mortality. Drug overdose remained a major contributor to the deficits in the US and UK. Moving from younger to older age groups, the researchers noted a shift from external causes (such as drug overdose and firearm-related deaths) and perinatal conditions and congenital abnormalities to circulatory diseases, lung diseases, cancers, mental disorders, and nervous system diseases as major contributing factors.
“Some of these may be related to a sedentary lifestyle, high rates of obesity, unhealthy diet, stress, and a history of smoking,” Ho said. “These unhealthy behavior patterns are likely to put Americans at a disadvantage in terms of health and vitality.”
When comparing geographic differences in life expectancy within each country, Canada and the US had the lowest-performing regions, with 13 US states in the lowest category for both men and women. Australia performed particularly well, except for the Northern Territory, which has a larger Indigenous population than other states or territories. There, life expectancy was 6.20 years lower for men and 4.96 years lower for women than in the top-performing state.
Looking at the equality of mortality spread within each country, Australia was found to have the lowest within-country disparity for men and women, particularly those over 40, followed by Canada. For women, disparities were highest in New Zealand, Ireland and the United States. For men, disparities were highest in New Zealand, the United Kingdom and the United States.
“What the study shows is that a peer country like Australia is performing much better than the United States and is able to control young adult mortality,” Ho said. “They have really low levels of gun deaths and homicides, lower levels of drug and alcohol use, and better performance in chronic diseases, the latter pointing to lifestyle factors, health behaviors and health care performance.”
Researchers have suggested several reasons why life expectancy in Australia is higher than in other high-income English-speaking countries. One factor is that immigrants, who made up 30% of the population in 2018, tend to have a higher life expectancy than native-born people, so they contribute positively to national life expectancy. Australia has also established strong public health initiatives on drug and alcohol abuse and mental health, and has strict gun laws. Finally, the advantages seen in heart and lung disease, cancers and congenital disorders are linked to superior health service performance in cancer screening and treatment, flu vaccination and heart disease prevention, diagnosis and treatment.
“Australia is a model for how Americans can achieve a better life expectancy and not just a higher life expectancy but also less geographic inequality in life expectancy,” Ho said.
The study was published in the journal BMJ Open.
Source: Penn State